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Department of
SOCIAL SERVICES

Community Care Licensing


FACILITY EVALUATION REPORT

Facility Number: 075600504
Report Date: 02/22/2023
Date Signed: 03/13/2023 05:12:17 PM

Document Has Been Signed on 03/13/2023 05:12 PM - It Cannot Be Edited

STATE OF CALIFORNIA - HEALTH AND HUMAN SERVICES AGENCY

FACILITY EVALUATION REPORT		CALIFORNIA DEPARTMENT OF SOCIAL SERVICES
COMMUNITY CARE LICENSING DIVISION
CCLD Regional Office, 1515 CLAY STREET, STE. 310
OAKLAND, CA 94612
FACILITY NAME:JOANN'S CARE HOMEFACILITY NUMBER:
075600504
ADMINISTRATOR:BARRADAS, JOANNFACILITY TYPE:
735
ADDRESS:763 SOLANO COURTTELEPHONE:
(510) 773-4623
CITY:EL SOBRANTESTATE: CAZIP CODE:
94803
CAPACITY: 6CENSUS: DATE:
02/22/2023
TYPE OF VISIT:Required - 1 YearUNANNOUNCEDTIME BEGAN:
11:40 AM
MET WITH:Joann Barradas, AdministratorTIME COMPLETED:
01:30 PM
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On 02/22/2023 at 11:35 PM, Licensing Program Analyst (LPA) L. Holmes arrived unannounced to conduct an Infection Control Inspection. LPA was greeted by one staff upon entry and explained the purpose of the visit. The Administrator, Joann Barradas, was telephoned by the staff member and arrived 10 minutes later.

Facility has a COVID-19 Infection Control Plan on file. LPA requested a staff and resident roster. LPA observed a screening station at the entry that contained a thermometer, hand sanitizer, masks, gloves, gown, COVID-19 signage, and a sign-in log. LPA toured the facility including, but not limited to common areas, bathroom, kitchen, storage area and backyard. LPA observed mask, cough etiquette, social distancing and hand washing signs posted throughout. There was a sufficient supply of 2-day perishables and 7-day supply of non-perishable foods. All hand washing stations were equipped with soap, paper towels and covered garbage cans. There is a surplus of PPE stored in a bin and centrally located inside the facility that is accessible to all care staff. Hot water temperature in the shared residents' bathroom was measured at 111 degree Fahrenheit (F) and the facility's temperature was 70 degree (F). Fire extinguisher was observed full and last inspected on 11/18/2022. Smoke/Carbon Monoxide detectors were observed operational and first aid kit complete.

The following forms are to be updated and submitted to CCLD:
-LIC500 Personnel Report
-LIC308 Designation of Administrative Responsibility
-LIC610 Emergency Disaster Plan - change date 2023
-An updated copy of Administrator Certificate(s)

Exit interview conducted and a copy of this report provided.

SUPERVISORS NAME: Yvonne Flores-Larios
LICENSING EVALUATOR NAME: Lisha Holmes
LICENSING EVALUATOR SIGNATURE: DATE: 02/22/2023
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE: DATE: 02/22/2023
This report must be available at Child Care and Group Home facilities for public review for 3 years.

LIC809 (FAS) - (06/04)
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